Examining Changes in the Mental Health Status of Refugees Over the First Six Months of Resettlement Using the Refugee Health Screener-15 (RHS-15)

Refugees are people forced to leave their native countries and unable to return due to fear of war, violence, or political instability. Every year about 69,987 refugees resettle in the United States and approximately 1,200 refugees arrive in Utah. Refugees face various challenges, such as language and cultural barriers and adapting to a new environment, placing them at higher risk for depression, post-traumatic stress disorder, and panic attacks. Currently, the Utah Department of Health (UDOH) utilizes the Refugee Health Screener-15 (RHS-15) tool to evaluate the mental health status of refugees 14 years of age and older at 1, 3 and 6 months after resettlement. The RHS-15 is a validated and culturally sensitive tool designed to assess the range of emotional distress in refugees14 years and older. It is composed of two parts: Part I includes 14 symptom questions ranked on a scale of 0 to 4 and part II consists of a distress thermometer ranked on a scale of 0 to 10. The refugees scoring ≥12 on questions 1-14 or ≥ 5 on the distress thermometer are identified as symptomatic individuals who may benefit from the mental health services. Over the past 3 years, UDOH has partnered with resettlement clinics and agencies to screen refugees ≥ 14 years old at three intervals over a 6-month period to identify more refugees in need of mental health services. However, the changes in the mental health status of refugees over the first 6 months of resettlement have not been determined. Examining the changes over time in the mental health status of refugee population will help determine the need for routine mental health screening during their resettlement period and establish evidence based underpinnings for continued use. The purpose of this project is to examine the changes in the mental health status of refugees over the first 6 months of resettlement. The four primary objectives for the project were to: (a) obtain deidentified RHS-15 data for newly arrived refugees ≥ 14 years old, (b) examine changes in the mental health status of refugees ≥ 14 years old at three intervals, (c) evaluate the prevalence of mental health referrals by age group, gender, ethnic group, and country of origin at three intervals, and (d) disseminate the findings. The University of Utah and UDOH Institutional Review Boards approved this project. The analysis results show that in the Utah approximately 1,014 refugees ≥ 14 years old received at least one mental health screening using the RHS-15 tool between June 2014 and June 2015. However, only 197 refugees received RHS-15 screening at the three intervals. The results show that the mean RHS-15 scores on questions 1-14 were lowest at the 1-month screening and highest at the 3-month screening. Thus, mental health distress in refugees significantly increased during the 3 months of their resettlement, which suggests month 3 is the optimum time to screen refugees for further mental health problems. The project also demonstrated that mental health distress during the resettlement is higher in refugees age 65 and older and closer mental health screening follow up is recommended for refugees older than 65 years old.